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Cadmium poisoning

 

Definition

Cadmium is a metal with an atomic weight of 112.41. In the Periodic Table of the Elements, cadmium is located between zinc and mercury. It is used in a large number of industrial applications. In the United States, over 10 million pounds of cadmium are used industrially every year.

The uses for cadmium include:

  • component of several metal alloys
  • component of solder (metallic cement), particularly solder for aluminum
  • electroplating
  • nickel plating
  • engraving
  • cadmium vapor lamps
  • nickel-cadmium batteries
  • treatment of parasites in pigs and poultry

Cadmium can be very toxic, and is dangerous if it is swallowed or inhaled. While spontaneous recovery from mild cadmium exposure is common, doses as low as 10 milligrams can cause symptoms of poisoning. There is no accepted fatal dose amount.

Description

The symptoms of ingested cadmium poisoning are:

  • increased salivation
  • choking
  • vomiting
  • abdominal pain
  • anemia
  • painful spasms of the anal sphincter

When cadmium dust or powder is inhaled, the first symptoms are a sweet or metallic taste, followed by throat irritation. Other symptoms that may appear in three to five hours include:

  • dry throat
  • cough
  • headache
  • vomiting
  • chest pain
  • pulmonary edema, a congestive lung condition
  • bronchospasm, the abnormal tightening of airways that may be accompanied by wheezing and coughing
  • pneumonitis, inflammation of the lung
  • muscle weakness
  • leg pain

When a person has exposure to cadmium in low doses over a long period of time, symptoms may include loss of sense of smell, cough, shortness of breath, weight loss, and tooth staining. Chronic cadmium exposure may cause damage to the liver and kidneys.

Causes & Symptoms

The most common cause of cadmium poisoning is a lack of proper precautions in places where cadmium is used. In such industries, air quality should be regularly monitored. Cadmium-plated containers should never be used to store acidic foods such as fruit juices or vinegar.

Fossil fuels, such as coal and oil, release cadmium fumes into the air. Chronic cadmium poisoning is also possible through soil or water contamination. This problem may occur with improper disposal of nickel-cadmium batteries used in items such as cameras. Cadmium poisoning has been associated with Itai-Itai disease in Japan.

Diagnosis

Cadmium poisoning is usually diagnosed by its symptoms, particularly if there is reason to believe that the patient has been exposed to cadmium. Because patients may not request treatment for up to a day following cadmium exposure, diagnosticians should carefully question any patient who shows symptoms consistent with this condition.

Treatment

Other than symptomatic treatment, there are no good options for dealing with cadmium poisoning. Hemodialysis may be used to remove circulating cadmium from the bloodstream, although the literature on the subject is scarce. Addition of a chelating agent, particularly ethylenediamine tetraacetic acid (EDTA), will increase the amount of cadmium removed by the dialysate (the fluid used in dialysis to carry substances to or remove from the kidney during hemodialysis).

These treatments are only effective for oral poisoning, and have no demonstrated benefit in cadmium fume inhalation.

Allopathic Treatment

There are no generally accepted treatments for the acute effects of cadmium poisoning. Other than dialysis, dimercaptosuccinic acid (DMSA) (an oral chelating agent), has been recommended for removal of cadmium from the blood.

Expected Results

The prognosis depends on the nature and severity of the cadmium load. Most cases of mild exposure resolve spontaneously after a few days. In other cases, cadmium can lead to permanent damage with shortened lifespan, or even death.

Cadmium may be carcinogenic.

Long-term exposure may also result in bone defects including osteoporosis.

Prevention

All work done in areas where there may be cadmium fumes should be well ventilated. Ground water and soil should be checked for cadmium. Cadmium-coated containers should, in general, be avoided. They should never be used with acidic liquids such as fruit juices. Coal and oil-burning utilities should be monitored for cadmium discharge. Nickel-cadmium batteries should be recycled or disposed of as toxic waste.

Resources

Books

Driesbach, R. M. Handbook of Poisoning. 7th ed. Lange, 1971.

Ford, M. D. Toxicology. 1st ed. Philadelphia, PA: W. B. Saunders, 2001.

Goldman, L., and J. C. Bennet. Cecil Textbook of Medicine. 21st ed. Philadelphia, PA: W. B. Saunders, 2000.

Murray J. F., and J.A. Nadel. Textbook of Respiratory Medicine. 3rd ed. Philadelphia, PA: W. B. Saunders Company, 2000.

Periodicals

Davis, R. D. "Cadmium - A Complex Environmental Problem. Part II. Cadmium in Sludges Used as Fertilizer." Experientia (February 15, 1984): 117–26.

Organizations

Canadian Centre for Occupational Health and Safety. 135 Hunter Street, East Hamilton, ON Canada L8N 1M5.

[Article by: Samuel Uretsky, Pharm.D.]

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Cadmium poisoning
Classification and external resources
ICD-10 T56.3
ICD-9 985.5
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Cadmium has no constructive purpose in the human body. Cadmium and its compounds are extremely toxic even in low concentrations, and will bioaccumulate in organisms and ecosystems.

Contents

Sources of exposure

In the 1950s and 1960s industrial exposure to cadmium was high, but as the toxic effects of cadmium became apparent, industrial limits on cadmium exposure have been reduced in most industrialized nations and many policy makers agree on the need to reduce exposure further. While working with cadmium it is important to do so under a fume hood to protect against dangerous fumes. Silver solder, for example, which contains cadmium, should be handled with care. Serious toxicity problems have resulted from long-term exposure to cadmium plating baths.

Buildup of cadmium levels in the water, air, and soil has been occurring particularly in industrial areas. Environmental exposure to cadmium has been particularly problematic in Japan where many people have consumed rice that was grown in cadmium contaminated irrigation water. This phenomenon is known under the name itai-itai disease.[1]

Food is another source of cadmium. Plants may only contain small or moderate amounts in non-industrial areas, but high levels may be found in the liver and kidneys of adult animals.

Cigarettes are also a significant source of cadmium exposure. Although there is generally less cadmium in tobacco than in food[citation needed], the lungs absorb cadmium more efficiently than the stomach.[citation needed]

Aside from tobacco smokers, people who live near hazardous waste sites or factories that release cadmium into the air have the potential for exposure to cadmium in air. However, numerous state and federal regulations in the United States control the amount of cadmium that can be released to the air from waste sites and incinerators so that properly regulated sites are not hazardous. The general population and people living near hazardous waste sites may be exposed to cadmium in contaminated food, dust, or water from unregulated releases or accidental releases. Numerous regulations and use of pollution controls are enforced to prevent such releases.

Workers can be exposed to cadmium in air from the smelting and refining of metals, or from the air in plants that make cadmium products such as batteries, coatings, or plastics. Workers can also be exposed when soldering or welding metal that contains cadmium. Approximately 512,000 workers in the United States are in environments each year where a cadmium exposure may occur. Regulations that set permissible levels of exposure, however, are enforced to protect workers and to make sure that levels of cadmium in the air are considerably below levels thought to result in harmful effects.

Some sources of phosphate in fertilizers contain Cadmium in amounts of up to 100 mg/kg[2][3], which can lead to an increase in the concentration of Cadmium in soil (for example in New Zealand)[4]. Nickel-cadmium batteries are one of the most popular and most common cadmium-based products, and this soil can be mined for use in them.

An experiment during the early 1960s involving the spraying of Cadmium over Norwich has recently been declassified by the UK government, as documented in a BBC News article[5].

Clinical effects

Acute exposure to cadmium fumes may cause flu like symptoms including chills, fever, and muscle ache sometimes referred to as "the cadmium blues." Symptoms may resolve after a week if there is no respiratory damage. More severe exposures can cause tracheo-bronchitis, pneumonitis, and pulmonary edema. Symptoms of inflammation may start hours after the exposure and include cough, dryness and irritation of the nose and throat, headache, dizziness, weakness, fever, chills, and chest pain.

Inhaling cadmium-laden dust quickly leads to respiratory tract and kidney problems which can be fatal (often from renal failure). Ingestion of any significant amount of cadmium causes immediate poisoning and damage to the liver and the kidneys. Compounds containing cadmium are also carcinogenic.

The bones become soft (osteomalacia), lose bone mineral density (osteoporosis) and become weaker. This causes the pain in the joints and the back, and also increases the risk of fractures. In extreme cases of cadmium poisoning, mere body weight causes a fracture.

The kidneys lose their function to remove acids from the blood in proximal renal tubular dysfunction. The kidney damage inflicted by cadmium poisoning is irreversible and does not heal over time. The proximal renal tubular dysfunction creates low phosphate levels in the blood (hypophosphatemia), causing muscle weakness and sometimes coma. The dysfunction also causes gout, a form of arthritis due to the accumulation of uric acid crystals in the joints because of high acidity of the blood (hyperuricemia). Another side effect is increased levels of chloride in the blood (hyperchloremia). The kidneys can also shrink up to 30%.

Other patients lose their sense of smell (anosmia).

See also

References

  1. ^ Itai-itai disease: http://www.kanazawa-med.ac.jp/~pubhealt/cadmium2/itaiitai-e/itai01.html
  2. ^ Syers JK, Mackay AD, Brown MW, Currie CD (1986). "Chemical and physical characteristics of phosphate rock materials of varying reactivity". J Sci Food Agric 37: 1057–1064. doi:10.1002/jsfa.2740371102. 
  3. ^ Trueman NA (1965). "The phosphate, volcanic and carbonate rocks of Christmas Island (Indian Ocean)". J Geol Soc Aust 12: 261–286. 
  4. ^ Taylor MD (1997). "Accumulation of Cadmium derived from fertilisers in New Zealand soils". Science of Total Environment 208: 123–126. doi:10.1016/S0048-9697(97)00273-8. 
  5. ^ BBC News - Enquiry into spray cancer claims: http://news.bbc.co.uk/1/hi/england/norfolk/4507036.stm
  6. Shannon M. Heavy Metal Poisoning, in Haddad LM, Shannon M, Winchester JF(editors): Clinical Management of Poisoning and Drug Overdose, Third Edition, 1998.

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